Youth Transitional Plan

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Douglas Nichols
5 years ago
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1 COUNTY COMMISSIONERS John N. Lechner, Chairman Matthew B. McConnell Brian Beader COUNTY OF MERCER CHILDREN AND YOUTH SERVICES Albert E. Acker Building 8425 Sharon-Mercer Road Mercer, PA Telephone: (724) or (724) After hours/emergency (724) Fax: (724) Date this plan was developed: I am aware that I can remain in placement until age 21 if I am continuing with my education or I am involved in a course of treatment. Yes No N/A Housing A. Plan for housing while in placement (if applicable): While in placement I will live with: Name: Address: B. Plan for housing when I leave care or go out on my own: Address:

2 Include room and board (how much and who is paying for it): What the rules and expectations are for me: How much money will be available to me when I go out on my own and what the sources of that money are: Who will I be living with (include name of roommates or family members that you are planning to live with):

3 With who and where will I be staying on holidays or breaks: Name: Address: C. My back-up housing plan: If my plan for housing falls through, where will I live? What are my options? Please have two (2) options: Option #1: I will live: With:_ Options #2: I will live: With:_

4 Other housing questions to discuss: I understand that I may need to sign a contract for housing: Yes No Where do I get housing applications: Contact person: Date to be completed: Public Housing options in the area that I plan to live include: Who in my support system can help me with housing and how:

5 Education Are you a high school graduate or do you already have your GED? Yes No Current educational program (Include name, address and phone number of school or GED program): Planned date of graduation: Who are my current important education contacts (could include guidance counselor, teachers, principals, OVR representative, etc.): Name: Title: Phone: Name: Title: Phone:

6 Name: Title: Phone: Name: Title: Phone: Name: Title: Phone: Name: Title: Phone:

7 Post-Secondary Education Plan I plan to go to school after I am finished with high school or have my GED: Yes No If yes, I plan on attending: Name of school: Address of school: I plan on studying: Important contacts at planned school (include name, title, phone number and ): Name: Title: Phone: Name: Title: Phone:

8 Name: Title: Phone: I plan to enter the military: Yes No Which Branch of the military: Recruiter Name: Phone number: Other plans/needs for education include: Who in my support system can help me with education needs and how?

9 Transportation Do you have a driver s license or plan to get a driver s license? Yes No How I will get around: Public transportation in the area I plan to live includes: Other plans/needs for transportation include: Who in my support system can help me with transportation:

10 Financial Source of income: My budget includes: Do I have a savings or checking account: Yes No Other financial plans/needs include: Who in my support system can help me with finances and how:

11 Employment I am currently working at: Efforts I need to make to get a job: Workforces available to me: Other employment plans/needs include: Who in my support system can help me with employment and how:

12 Physical Health My insurance coverage will be (current and future): Doctor: Name: Address: Phone: Dentist: Name: Address: Phone: Eye Doctor: Name: Address: Phone:

13 Gynecologist or Pre-natal Care: Name: Address: Phone: Specialists: Name: Address: Phone: Name: Address: Phone: Who in my support system can help with my physical health:

14 Emotional Health Where I can go to have my emotional health needs met: Persons that can monitor medication for me: Name: Address: Phone: Who in my support system can help with my emotional health:

15 My Circle of Support Name: Address: Phone: Name: Address: Phone: Name: Address: Phone: Name: Address: Phone: Name: Address: Phone: Name: Address: Phone: Name: Address: Phone: Name: Address: Phone:

16 My 24 hour emergency contact is: Name: Address: Phone: Person I would like to make decisions for me if I am unable to make them for myself: Name: Address: Phone:

17 Life Skills What skills I already have: What skills I need and people that can help with these: Prevention My prevention plan includes:

18 Documents Documents I have: Documents I need and how I can get them: Social

19 Youth with a Child of Their Own Plan for where my child will live, supports for my child, childcare, medical care for child, etc.:

20 Things I need and want to get started: Other Areas Needing Addressed:

21 COUNTY COMMISSIONERS John N. Lechner, Chairman Matthew B. McConnell Brian Beader COUNTY OF MERCER CHILDREN AND YOUTH SERVICES Albert E. Acker Building 8425 Sharon-Mercer Road Mercer, PA Telephone: (724) or (724) After hours/emergency (724) Fax: (724) Signatures Youth Signature Date Parent/Guardiant s Signature Date Guardian Ad Litem s Signature Date IL Case Management/IL Coordinator s Signature Date CYS Caseworker s Signature Date CASA Representative s Signature Date

Main Street. Eligibility Criteria

Main Street. Eligibility Criteria Main Street Main Street Housing Programs offer a unique program consisting of Transitional Living for homeless young adults between the ages of 16-21 years of age. Participants are aided in developing